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Inspection Summary


Overall summary & rating

Good

Updated 14 February 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Ashraf Botros on 25 May 2017. The overall rating for the practice was good. However, within the key question of safe areas were identified as 'requires improvement' as the practice was not meeting the legislation for providing safe care and treatment. The practice was issued a requirement notice under Regulation 12, safe care and treatment. The full comprehensive inspection on 25 May 2017 can be found by selecting the ‘all reports’ link for the Dr Ashraf Botros on our website at www.cqc.org.uk. This inspection was a focused follow-up inspection carried out on 23 January 2018 to confirm the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations we identified at our previous inspection on 25 May 2017. This report covers our findings in relation to those requirements and also any additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings are as follows:

  • The practice had implemented an effective system to monitor patients on high risk medicines.
  • The practice had reviewed their emergency medicine provisions and a log of checks had been implemented for all medicines and emergency equipment.

In addition improvements had been made in the following areas we had recommended:

  • The practice had implemented a system to ensure that results were received for all samples sent for the cervical screening programme.
  • The practice had taken steps to improve uptake for national bowel and breast cancer screening programmes and they had taken steps to improve childhood immunisation uptake.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 February 2018

The practice is rated as good for providing safe services. The practice had implemented an effective system to monitor patients on high risk medicines, reviewed their emergency medicine provisions and a log of checks had been implemented for all medicines and emergency equipment.

Effective

Good

Updated 14 February 2018

Caring

Good

Updated 14 February 2018

Responsive

Good

Updated 14 February 2018

Well-led

Good

Updated 14 February 2018

Checks on specific services

People with long term conditions

Good

Updated 3 July 2017

The practice is rated as good for the care of people with long-term conditions.

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was comparable to other practices. For example,

    the percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less was 82% compared to the CCG average of 76% and the national average of 78%. Exception reporting for diabetes was 7% which was below the CCG average of 13% and the national average of 12%.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

  • All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 3 July 2017

The practice is rated as good for the care of families, children and young people.

  • From the sample of documented examples we reviewed we found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and

    emergency (A&E) attendances.

  • Childhood immunisation rates were in line with or below the 90% national target.

  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice worked with health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

Older people

Good

Updated 3 July 2017

The practice is rated as good for the care of older people.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • Where older patients had complex needs, the practice shared summary care records with local care services.

  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Working age people (including those recently retired and students)

Good

Updated 3 July 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 July 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

  • The practice carried out advance care planning for patients living with dementia.

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption has been recorded in the preceding 12

    months was 87% which is comparable to the CCG average of 92% and the national average of 89%. Exception reporting was 3% which was below CCG/national averages.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 3 July 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

  • All patients on the learning disability register had received an annual review.

  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.